Opioids cause clinically significant side effects such as respiratory depression, immunosuppression, muscle rigidity, negative inotropism, nausea, vomiting, hyperalgesia, urine retention, postoperative ileus, and drowsiness. Perioperative opioids are a major contributor to the United States’ and other countries’ opioid epidemics. Non-opioid analgesics, particularly lidocaine, are becoming more common for perioperative use as a result of this.

A total of 185 adult patients were randomly assigned to one of two groups: control group I (105 patients) [fentanyl group] or group ii (80 patients) [opioid-free anaesthesia group]. Lidocaine 1.5 mg/kg bolus followed by 1.5 mg/kg/h infusion intraoperatively, and 1.5-2 mg/kg/h infusion for 2-8 hours postoperatively were given to patients in both groups at anaesthetic induction. Intraoperatively, both groups received analgesic adjuvants such as diclofenac 75 mg, paracetamol 1 gm, and mgso4 30-50 mg/kg. If the mean arterial pressure (map) and/or heart rate (hr) increased by more than 20% over baseline, supplementary fentanyl 1 mcg/kg was given. Following intraoperative fentanyl administration, analgesic requirements were reported, as well as a visual analogue scale (vas) pain score evaluation at the time of immediate recovery and 24 hours later.

In 8.6% of instances in group I and 30% of cases in group ii, more intraoperative fentanyl was required. During the first 30 minutes, Group ii also required a greater minimum alveolar concentration (mac) of sevoflurane. If the procedures were less than 3 hours, both groups required analgesia right after extubation. After an 8-hour lidocaine infusion, no more opioids were required over the next 24 hours, and only 1 g paracetamol and/or 75 mg diclofenac were required in both groups. There were no significant variations in bowel function between the two groups.

Perioperative lidocaine infusion has been shown to be safe and effective. After a 24-hour period of non-opioid analgesia, a 5-8-hour post-operative lidocaine infusion was enough to relieve pain. Using opioids during induction improves hemodynamic stability and can be used in conjunction with lidocaine.

Author(S) Details

Vakhtang Shoshiashvili
Department of Anesthesiology and Intensive Care, TSMU First University Clinic,Tbilisi, Faculty of medicine, European University, Tbilisi, Georgia.

Ashraf El-Molla
Department of Anesthesia, Misr University for Science and Technology, Cairo, Egypt.

Fawzia Aboul Fetouh
Department of Anesthesia, Misr University for Science and Technology, Cairo, Egypt.

Rashed Alotaibi
Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia.

Abir Kandil
Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia.

Osama Shaalan
Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia.

Yasser Ali
Ministry of Health, Egypt.


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